Sato R, et al. – This retrospective cohort study aimed to investigate the effect of the physician–based emergency medical services (P–EMS) using a rapid response car (RRC) on door–to–extracorporeal membrane oxygenation (ECMO) time in patients with out–of–hospital cardiac arrest (OHCA). In prehospital settings, the physician–based RRC system was correlated with a shorter door–to–ECMO time and successfully advanced procedures. Among patients with OHCA, a combination of the RRC system with extracorporeal life support (ECLS) could lead to better outcomes.